The Politics of Health Care

If an avian flu pandemic were to strike Europe, who would set the policy for quarantines,
vaccine distribution, treatment protocols, and the like? The European Union? Individual
nations? An EU health committee? The short answer, says Scott Greer, an assistant professor of health management and policy and an expert in European
health care policy, is that no one knows.

That’s because when it comes to health policy, Europe has no clear-cut, mutually agreed-on
system of command. Through the European Court of Justice, the EU defines a set of
regulations under which its 25 member states can formulate health policy. But each
individual member state has its own autonomous health system, and the quality and
character of those systems vary immensely. Moreover, within each of those national
systems, at least three levels of government are at play—the EU itself, the federal
government, and regional governments. If something like bird flu were to break out,
local governments as well as organizations such as the World Health Organization would
also weigh in.

Potentially it’s a recipe for chaos, says Greer, who is trying to track what’s happening
in Europe today and to understand its significance. Having studied the intersection
of politics and health for years, he’s certain of this: some of the world’s most intractable
health problems are fundamentally political problems. Witness both Hurricane Katrina
and the 2004 outbreak of SARS, he says, where recovery and response efforts were plagued
by poor communication among various government agencies.

But it doesn’t take a disaster for problems to surface. Not long ago, a British woman
who’d been put on a wait list for a hip replacement elected to have the surgery in
France. When the British health system refused to pay for the operation, the woman
sued. The European Court ruled that under the rules of internal market competition,
Britain’s National Health System must pay. The court delivered the same ruling for
a similar case in the Netherlands.

Greer, who has published a book about the health policies of the UK and is now at
work on a comparative study of the health systems of the UK, Germany, France, and
Spain, says it’s a challenge simply to track these fast-changing developments, let
alone understand them.

His work is much needed, though. This summer, officials in the executive branch of
Scotland asked Greer to provide training to the country’s health services and public
health officials, so they’d have a better grasp of how the various layers of government—EU,
national, regional, local—affect their ability to make policy. He’s doing similar
work with the Royal College of Physicians of London, the UK Department of Health,
and the British Medical Association.

Greer expects his research to be useful to other European nations, as well, and ultimately
to shed light on health care in the United States. With the looming threat of an avian
flu pandemic, his efforts couldn’t be more timely.

Photo by Peter Smith.

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